1. APPLICATION FOR THE POST OF___________________________________-
Affix your
recent
passport size
photograph
01. Name of Applicant :
02. Father's / Husband's Name :
03. Date of Birth (DD/ MM / YYYY) :
04. Age as on 18.12.2014 ( supporting
Documents to be enclosed )
Years Month Days
05. Gender Male Female
06. Category (SC/ ST/ OBC / UR)
(Proof to be submitted)
07. Whether Physically handicapped (Yes/
No) If yes, nature of disability and its
degree (supporting documents to be
attached)
:
08 Mailing Address
(With Pin Code)
:
09. Permanent address (With pin code) :
10. Demand Draft Details :
11. Educational Qualifications (starting
from SSC / SSE (10th onwards)
:
S. No Academic
Qualification
Name of
Board /
University
Year of
Passing
Subject(s) % age of
marks
obtained
Class /
Division
12. List of documents attached :
i) Proof of age ii) Proof of educational qualification
iii) Caste certificate, if applicable iv) Disability certificate if applicable
13. Experience: (Attach proof) :
Organization Post held Period Present
pay scale
Nature of
duties
Declaration:
Certified that the information furnished above is true and correct to the bests of my knowledge
and belief and in case the same is found false or incorrect at any stage, my candidature /
appointment may be cancelled / terminated.
Date………………..
Place……………….. Signature
